COVID-19 Outcomes and Liver Disease

Abstract

The novel severe acute respiratory syndrome coronavirus (SARS CoV-2) is the cause of coronavirus disease (COVID-19), a pandemic that represents a global health challenge. COVID-19 is usually a self-limiting disease; however, it is associated with a significant (3–7%) mortality rate. The excessive production of pro-inflammatory cytokines because of SARS-CoV-2 infection is mainly associated with high mortality due to multiple organ failure. The global burden of chronic liver disease (CLD) is vast. Approximately 122 million people worldwide have cirrhosis, 10 million living with decompensated cirrhosis. The preexisting chronic liver disease is associated with inflammation and immune dysfunction that might predispose to poor clinical outcomes in COVID-19, such as disease severity, rate of ICU admission, and mortality. The overlapping risk factors for SARS CoV-2 and chronic liver diseases such as obesity, advanced age, diabetes, and metabolic dysregulation are the major causes of these poor outcomes. Furthermore, progressive liver disease is associated with immune dysregulation, contributing to more severe COVID-19. This book chapter will explain the natural history and pathogenesis of COVID-19 in CLD patients along with the likely underlying SARS CoV-2-related liver injury mechanisms.